Objective To explore the relationship between different smoking status and hypothyroidism in six iodine-suitable areas of China. Methods A total of 8187 residents were investigated by cluster sampling in six cities, and 7448 residents were included in the survey. The height, weight, waist circumference, and blood pressure were measured by filling out epidemiological questionnaire. Blood samples were collected to detect thyroid stimulating hormone ( TSH) , thyroid peroxidase antibody ( TPOAb) , and thyroglobulin antibody ( TgAb) . Results The mean TSH, TPOAb, and TgAb positive rates in passive smoking and active smoking groups were all lower than those in non-smoking group ( all P<0.01) . In the active smoking group, the TSH value decreased by 0.023 units for every unit increase in smoking index. The positive rates of TgAb and TPOAb in both passive smoking and active smoking groups were lower than those in non-smoking group (all P<0.01). Active and passive smoking reduced the prevalence of hypothyroidism (both P<0.01). Among women, the risks of clinical hypothyroidism and subclinical hypothyroidism were reduced in both active and passive smoking groups. Besides, the risk of subclinical hypothyroidism decreased significantly when the smoking index was more than 70. In male population, the risk of subclinical hypothyroidism in active and passive smoking group decreased. Besides, the risk of clinical hypothyroidism and subclinical hypothyroidism decreased significantly when the smoking index was more than 70. Conclusion Smoking in iodine-suitable areas may reduce TSH level and the positive rates of TPOAb and TgAb.

Objective To study the relationship between liver enzymes [ alanine transaminase ( ALT), gamma-glutamyltransferase ( GGT), aspartate amino transferase ( AST)] and the incidence of impaired glucose tolerance(IGT) in middle-aged and elderly people. Methods A group of middle-aged and elderly residents who participated in the REACTION study in 2011 from Guiyang community were enrolled in our study. Of which, a total of 4228 participants with normal blood glucose detected by oral glucose tolerance test (OGTT) and serum ALT levels were investigated as baseline population. The baseline survey included questionnaire survey and physical examination (height, weight, waist circumference, blood pressure, etc. ), and the serum ALT, AST, GGT, total cholesterol ( TC ), triglyceride ( TG ), high density lipoprotein-cholesterol ( HDL-C ), low density lipoprotein-cholesterol (LDL-C), fasting blood glucose, postprandial 2h plasma glucose(2hPG) in OGTT, and fasting insulin(FINS) were tested. After 3 years of follow-up, all subjects received quartile grouping according to the basal liver enzyme levels, and the incidence of IGT was respectively calculated. One-way analysis of variance was used to compare the differences of basal liver enzyme levels between IGT and normal blood glucose groups. The risk of IGT based on quartile grouping was assessed by multivariate regression analysis, and the odds ratios (ORs) were estimated by the logistic regression model. Results After eliminating the 35 died patients, 3188 participants were followed over 3 years. Among them, 2400 subjects revealed normal blood glucose level, 61 developed into type 2 diabetes mellitus(T2DM), 91 developed into IFG, and 636 developed into IGT. The incidence of IGT increased along with the elevation of serum ALT level (P<0. 01). After adjusting the risk factors including body mass index, regular smoking, regular drinking, regular exercise, family history of diabetes,homeostasis model assessment for insulin resistant index(HOMA-IR), post-load 2h blood glucose, and GGT, the results manifested that patients in high basal ALT level group had 1. 462-fold chance of susceptibility in developing IGT compared with that in the low level group, with 95％ CI of 1. 129 to 1. 891. The analysis based on gender showed that the incidence of IGT was associated with basal ALT level in the female group. The OR value was estimated to be 1. 481(95％ CI 1. 107-1. 981) in high basal ALT level group as compared with the low level group. Basal serum GGT and AST levels were not associated with the incidence of IGT. Conclusion Even an elevated level of ALT within normal reference range also tends to be a risk factor for IGT in middle-aged and elderly women.

Objective To investigate the accumulative 3-year morbidity of diabetes in the residents aged 40 years and above in a community of Guiyang and the risk factors. Methods A total of 10140 permanent residents aged over 40 years in a community of Guiyang were selected from May 2011 to October 2011 using randomized sampling. This population was followed up again in 2014. Questionnaires, physical examination, blood lipids and oral glucose tolerance test were performed among the subjects of study for two surveys with the same criteria. Finally, 5958 subjects with complete data and without baseline diabetes at the two time points were enrolled in this study for analysis. Results The 3-year accumulative morbidity of diabetes in this population was 6. 13％ (6. 59％ in males, 5. 65％ in females). The main factors influencing the incidence of diabetes mellitus were age (OR = 1. 589, 95％ CI 1. 395-1. 809, P<0. 01), body mass index ( OR = 2. 012, 95％ CI 1. 632-2. 479, P<0. 01), pulse rate ( OR =1. 019, 95％ CI 1. 012-1. 025, P<0. 01), family history (OR = 1. 700, 95％ CI 1. 299-2. 225, P<0. 05), fasting plasma glucose at baseline(OR = 3. 132, 95％ CI 2. 478-3. 958, P<0. 01), 2 h plasma glucose at baseline( OR =1. 698,95％ CI 1. 574-1. 832, P < 0. 01), total cholesterol ( OR = 1. 350, 95％ CI 1. 060-1. 719, P < 0. 05), triglyceride(OR=2. 196, 95％ CI 1. 758-2. 743, P<0. 01),high density lipoprotein-cholesterol(OR = 0. 540, 95％CI 0. 375-0. 776, P < 0. 01), and low density lipoprotein-cholesterol ( OR = 1. 614, 95％ CI 1. 094-2. 382, P<0. 05). Conclusion 3-year morbidity of diabetes in Guiyang was 6. 13％ . The incidence of diabetes is notably correlated with aging, faster pulse frequency, overweight and obesity, higher baseline blood glucose, and dyslipidemia.

A total of 10140 adult residents aged 40-80 years living for more than five years in Yunyan district of Guiyang were recruited by cluster sampling method from May to October, 2011. The epidemiological questionnaire investigations were performed in all subjects and basic information was collected. Body mass index (BMI), waist circumference, blood pressure, blood glucose, blood lipids, serum insulin, and TSH levels were measured. The results showed that the prevalence of metabolic syndrome ( MS) was 40. 3％ in 7743 subjects with normal thyroid function, which was 27. 4％ for men and 45. 6％ for women. The TSH level in MS group was significantly higher than that in non-MS group [(2. 63 ± 1. 01 vs 2. 53 ± 1. 04) mU/ L, P < 0. 01]. Significant differences in BMI, triglycerides(TG), and high density lipoprotein cholesterol(HDL-C) were found in groups with different TSH levels(P<0. 05). The normal TSH level was positively related to TG, fasting insulin,and the prevalence of MS after adjusting for age, BMI, and homeostasis model assessment for insulin resistance ( P < 0. 05). Logistic regression showed that the TSH was an influencing factor for MS(OR=1. 056, 95％ CI 1. 004-1. 111).

Objective To explore the epidemiological characteristics of the prevalence and incidence of metabolic syndrome(MS) in subjects with different TSH levels, which can provide a certain clinical basis for the prevention and treatment of MS. Methods According to the reference range of the TSH test system in our hospital, the subjects were divided into TSH normal group and TSH elevation group. From May to August of 2011, the whole group sampling method was used to conduct a baseline survey of 10140 permanent residents aged 40 and above in Yunyan district of Guiyang City. A total of 9618 cases were included. The prevalence of MS and its components were calculated with different TSH levels at baseline. After eliminating 3926 MS in 2011, 5692 patients with no MS were followed up for 3 years. Incidence of MS and its components were compared among different TSH levels. The median follow-up was (38. 6 ± 1. 6) months and the completion rate was 75. 40％. Results The total crude and standard prevalence of MS were 40. 82％ and 34. 46％ respectively. The crude and standard prevalence of MS in TSH normal group were 39. 96％ and 33. 90％, respectively, and in TSH elevation group were 44. 3％ and 37. 56％respectively . The comparison of crude prevalence of MS between the two groups was statistically significant (P>0. 05) and the standard prevalence of MS in TSH elevation group was also higher than that in TSH normal group. After 3 years of follow-up, the total crude and standard incidences of MS were 22. 51％ and 20. 64％, respectively. The total crude and standard incidence of MS in TSH normal group were 22. 01％ and 20. 22％, respectively and in TSH elevatlon group were 24. 69％ and 23. 20％, respectively. There was no statistically significant difference between crude incidences of MS in two groups, but the standard incidence of MS in TSH elevation group was higher than that in TSH normal group. Binary Logistic regression analysis showed that there was a positive correlation between TSH and incidence of MS in TSH elevation group. Conclusion Higher than normal levels of TSH may increase the prevalence and incidence of MS and its some components.

Objective To investigate the association between blood glucose level and cardiovascular disease ( CVD) risk in elderly people aged 40 and older in Guiyang City. Methods Population-based cross-sectional studies on diabetes were performed in 10140 adults, aged 40-78 years, living in the Yunyan Community in Guiyang City, during May, 2011 to August, 2011. The fasting venous blood samples were drawn for the measurements of serum creatinine(Cr), fasting plasma glucose(FPG), OGTT 2hPG, fasting triglyceride(TG), total cholesterol(TC), high-density lipoprotein-cholesterol ( HDL-C ) , low-density lipoprotein-cholesterol ( LDL-C ) , and fasting plasma insulin. The diabetes status and the classification system for diabetes in our study were categorized according to the Diabetes Diagnostic Standard which was issued by WHO in 1999. An estimated 10-year Framingham risk for coronary heart disease was calculated. Results Compared with those in normal glucose regulation( NGR) group, the subjects in abnormal glucose metabolism were associated with higher prevalence of various cardiovascular risk factors, including age, body mass index, blood pressure, HbA1C , HOMA-IR, total cholesterol, triglycerides, waist circumference, waist-hip ratio, and creatinine, as well as 10-year Framingham risks for coronary heart disease. The difference was statistically significant ( all P<0. 05 ) . Men were more likely to have cardiovascular risk than women. Women developing the disease only begins to increase after the age of 59. The difference was statistically significant(P<0.05). Compared with the subjects in NGR group, the 10-year Framingham risk for coronary heart disease in impaired fasting glucose ( IFG ) , impaired glucose tolerance ( IGT ) , and diabetes mellitus ( DM ) groups shown 10％of increase were 1.13( OR=1.13, 95％CI 0.81-1.58, P>0.05) , 1.18( OR=1.18, 95％CI 0.95-1.45, P>0.05), and 1.44(OR=1.44, 95％CI 1.10-1.88, P<0.05), respectively, after adjusting for various influencing factors. Conclusion Diabetic patients and pre-diabetic individuals were independently associated with the increased 10-year risks for CVD.

Objective To investigate the composition and pathological subtypes of thyroid cancer in patients with thyroid nodule surgery in Guiyang in recent 8 years, and to analyze their influencing factors. Methods A retrospective pathological analysis of 4 262 thyroid surgery cases in Affiliated Hospital of Guizhou Medical University during the 2009-2016 to investigate the proportion of thyroid cancer and pathological subtype. The iodine content of salt was reduced at the end of 2012 in Guiyang. 2009-2012 as the pre down-regulation group(n＝1 572), 2013-2016 as the after down-regulation group ( n＝2 690), then comparative analysis before and after the adjustment of the iodine content of salt composition of thyroid cancer and changes of pathological subtype was performed. Results From 2009 to 2016, the proportion of thyroid cancer were 17.08%, 17.52%,15.65%, 18.58%, 19.80%, 29.35%, 35.34%, and 48.33%, increased year by year (P＜0.05). Thyroid microcarcinoma were 2.14%, 4.74%, 3.40%, 3.65%, 3.80%, 7.03%, 9.10%, and 25.95%(P＜0.05). The constituent ratio of thyroid cancer after adjustment of salt iodine content was higher than before. Papillary thyroid carcinoma is the main pathological subtype before and after adjustment of salt iodine content. The proportion of female patients was higher than that of males. The age of patients with thyroid cancer after adjustmen was higher than before ( P＜0. 05). Conclusions In the past 8 years, the constituent ratio of thyroid cancer and thyroid microcarcinoma in Guiyang increased year by year. The reason may be related to the increase of radiation in the environment, the improvement of medical level and the higher detection rate of thyroid microcarcinoma. The relationship between iodine nutrition and thyroid cancer needs to be further studied.[Key words] Thyroid cancer; Thyroid microcarcinoma; Thyroid papillary carcinoma; Pathological type;Iodized salt; Iodine nutrition

Objective To analyze of the prevalence of encapsulated follicular variant of papillary thyroid carcinoma (EFVPTC) and noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) by 2017 World Health Organization ( WHO) classification of tumors of endocrine organs in Guiyang. Methods A retrospectively analysis of patients who had a thyroid surgery and confirmed thyroid cancer by pathological diagnosis in the Affiliated Hospital of Guizhou Medical University from 2009 to 2016. PTC and FVPTC by 2014 WHO classification of tumors of endocrine organs , and according to the 2017 WHO classification of tumors of endocrine organs ,the thyroid papillary carcinomas were reviewed and some had been confirmed as EFVPTC and NIFTP, with analysis of the prevalence and prognosis of NIFTP. Results Of the 1207 cases of thyroid carcinoma, 1150 cases were papillary carcinoma, the constituent ratio of thyroid carcinoma was 95.28％, the FVPTC was 72 cases, and the proportion of thyroid carcinoma was 5. 97％; the proportion of FVPTC in thyroid carcinoma decreased from 2009 to 2016 ( P <0.05). After pathological sections being reviewed, 10 cases had been confirmed as non-encapsulated infiltrative FVPTC, the ratio of thyroid cancer to thyroid cancer was 0.83％; EFVPTC was found in 62 cases, accounting for 5.14％ of thyroid carcinoma, these included 2 cases of NIFTP confirmed by the 2017 WHO classification of tumors of endocrine organs and 60 cases encapsulated invasive FVPTC, the percentage of thyroid carcinoma was 0.17％ and 4.97％. 62 cases of EFVPTC with the exception of 11 cases without further visit, while the remaining 51 cases of EFVPTC were followed up. Death, local or distant metastases were defined as adverse events. An adverse event was seen in 11 of 49 of the cases of invasive EFVPTC, including 2 died of disease; The NIFTP were alive with no evidence of disease. Conclusion The diagnosis of NIFTP according to new WHO classification of endocrine organ tumors in 2017 has little expected impact in Guiyang.

Objective To investigate the change of prevalence of autoimmune thyroiditis in Guiyang city after adjustment of salt iodine content, and to study the link between the level of iodine intake and the development of autoimmune thyroiditis. Methods With cluster sampling method, a cross-sectional study was conducted among adults aged 20 years old or above in Guiyang in 2009 (before adjustment, n=1 509) and 2015 (after adjustment, n=1 368). After an overnight fasting, thyroid stimulating hormone (TSH), thyroid peroxidase antibody (TPOAb), and thyroglobulin antibody (TgAb) were measured. The serum FT4 and FT3 were determined for the subjects with abnormal TSH. Meanwhile, urine iodine levels of children aged 8-10 years old in the same community were measured after an overnight fasting in these two studies. Results In 2009, the median level of 8-10 years old children′s urinary iodine was 228.7 μg/L. The prevalence of positive TPOAb, positive TgAb, and thyroid autoantibodies (TAAs) were 14.38%, 13.59%, 18.89%, the standardized prevalence were 14.35%, 13.59%, 18.89% respectively. The prevalence of subclinical hypothyroidism, autoimmune thyroiditis were 14.12% and 4.44%, with the standardized prevalence were 14.12%, 4.42% respectively. In 2015, the median urinary iodine level of 8-10 years old children was 190.1 μg/L, the prevalence of positive TPOAb, positive TgAb, and TAAs were 8.77%, 7.82%, 11.77%, the standardized prevalence were 8.98%, 7.97%, 12.13% respectively; the prevalence of subclinical hypothyroidism, autoimmune thyroiditis were 22.89%, 2.92%, with the standardized prevalences of 23.19%, 3.02% respectively. Conclusion After adjustment of salt iodine content, the iodine nutrition in Guiyang is at the appropriate level, and the values of TPOAb, TgAb, TAA, and autoimmune thyroiditis in adults of Guiyang city were all decreased.

Objective To explore the relationship between metabolic syndrome(MS) and glomerular filtration rate(GFR).Methods A total of 10 140 adults aged 40 years and older inhabitants in Zhaiji community of Guiyang urban areas were investigated from May 2010 to August 2010 by adopting stratified cluster sampling method.The venous blood sample was drawn for the measurements of serum creatinine(Cr), fasting plasma glucose(FPG), OGTT 2hPG, fasting insulin, triglyceride(TG), total cholesterol(TC), high-density lipoprotein-cholesterol(HDL-C), low-density lipoprotein-cholesterol(LDL-C), and fasting plasma insulin.The definition of MS in our study was modeled after the Adult Treatment Panel Ⅲ(ATP-Ⅲ).Decreased GFR was defined as an estimated GFR<60 ml·min-1·(1.73 m2)-1.Results The prevalence of GFR less than 60 ml·min-1·(1.73 m2)-1 were 3.0% and 1.2% in participants with and without MS, respectively.The multivariate-adjusted odds ratios[95% confidence interval(CI)] of MS, which were independently associated with decreased GFR, were with elevated blood pressure, higher TG, lower HDL-C, and elevated FPG, their statistically odds ratios were 1.78, 2.96, 1.06, and 1.22, respectively.The prevalence of GFR decreased with the increase of MS components by 0.56%, 1.10%, 1.50%, 2.87%, 3.23%, and the odds ratios were 1.00, 1.57, 1.93, 3.07, and 2.89, respectively.Conclusion With the increase of MS components the risk of GFR decline increased.The occurrence of chronic renal dysfunction(CKD) might integrate multiple different risk factors of MS.